Individual
AMBER LAURA CORNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
125 BROADWAY AVE, PUEBLO, CO 81004
(719) 404-0087
(719) 404-0087
Mailing address
1027 W 17TH ST, PUEBLO, CO 81003
(719) 404-0393
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
903891
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02704749
—
CO
Enumeration date
08/28/2006
Last updated
07/08/2007
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